Senators Grill Price, but He Stands His Ground

WASHINGTON — Repeal of the Affordable Care Act and its consequences were on the hot seat as senators questioned Rep. Tom Price, MD (R-Ga.) Wednesday about his fitness to serve as Secretary of Health and Human Services.

“I have serious concerns about your qualifications for the department you hope to lead,” said Sen. Patty Murray (D-Wash.), ranking member of the Health, Education, Labor, & Pensions (HELP) Committee, at a hearing on the nomination. “Just last week you voted to begin the process of ripping apart our healthcare system without any plan to replace it, even though [it’s estimated that] 30 million people will lose their coverage.”

Wednesday’s hearing was a “courtesy” hearing before the committee, which is not tasked with sending Price’s nomination to the Senate floor for a vote. That responsibility falls to the Senate Finance Committee, which is scheduled to hold a formal confirmation hearing and vote on the Price nomination next Tuesday.

Healthcare for All

Price maintained that if he is confirmed, he will fulfill president-elect Donald Trump’s promise of healthcare for everyone. “The principles that I think are absolutely imperative for the healthcare system is one that’s affordable for everybody, one that provides access to health coverage and care for everybody, one that’s of highest quality, that’s responsive to patients … one that incentivizes innovation, and that insures choices are made and preserved by patients,” he said.

Access was a word that Price returned to frequently when he was asked if he would guarantee that certain groups would not lose healthcare coverage under a replacement for the ACA. “It’s incredibly important that we have a system for every single American to have access to the kind of coverage they need and desire,” he said in answer to another question.

Access to health insurance is not an exact match for President-elect Donald J. Trump’s promise of health insurance for all, a point hammered home by Vermont Sen. Bernie Sanders, the independent who challenged Hillary Clinton for the Democratic nomination. “I have access to buying a $10 million home. I don’t have the money to do that,” Sanders said.

Democratic senators also pressed Price on potential conflicts of interest, specifically his healthcare stock trades, several of which been the subject of media coverage. Price maintained that many of his stock trades are done through a broker so he is not always aware of them, and that he has disclosed any relevant trades as required by the House Office of Government Ethics.

In response to questions about his purchase of stock in six pharmaceutical companies shortly before introducing a bill blocking a regulation that would likely have hurt those same companies, he noted that “My opposition to having the federal government dictate what drugs are available to patients is longstanding.”

Contraception Coverage

Murray also asked Price about his views on paying for contraceptive coverage. “You have said you don’t think cost is an issue for women in buying birth control and stated, ‘Bring me one woman who has been left behind … there is not one,’ correct?” she said.

“I think what I said and what I meant was that when I had patients in my office who were unable to afford medication, we did everything we could to make certain they got that medication. What I meant to capture in that conversation was that if there are individuals who are unable to afford that med, or any med, that there are avenues within the healthcare system physicians and others take to make sure individuals receive medication that they need.”

Murray related the example of a constituent diagnosed with endometriosis who takes contraceptives for chronic pain and who told Murray that “No copay birth control is an essential tool for helping women like me with endometriosis who otherwise would have to live with chronic pain.”

“Women are deeply concerned about the impact this election could have on access to healthcare they need; I’ve heard from many of them,” said Murray. “Will you commit to ensuring all 18 FDA-approved methods of contraception continue to be covered so women don’t have to go back to paying extra costs for birth control?”

“What I will commit to … is that we believe strongly that every single American ought to have access to the kind of coverage and care they desire and want,” said Price. “That’s our commitment and it runs across the board.”

“Birth control is an essential part of women’s healthcare and if you are confirmed I will be holding you accountable for that,” Murray responded.

As was expected, Price received friendlier queries from Republicans on the HELP Committee. “You are clearly one of premier people in all of Congress to understand the problems of healthcare, and have the background … to solve the problems we have,” Sen. Orrin Hatch (R-Utah) said to Price, an orthopedic surgeon.

Sen. Rand Paul, MD (R-Ky.), also spoke favorably of Price. “I think what I regret about this kind of hearing is sort of the vitriol, the rancor and partisanship that should go into something; we want the same things. To question your motives is insulting; To question whether you’re honest is insulting … I think we all want the most amount of insurance for people, and the least amount of cost.”

Paul and Price discussed ideas that might be included in a Republican replacement for the ACA, including health savings accounts and high-deductible catastrophic coverage. “I think health savings accounts and high-deductible catastrophic coverage make a whole lot of sense for many individuals; they ought to have the choice,” said Price.

He also said a replacement plan could include high-risk pools to insure people who might otherwise have trouble getting coverage. Sen. Al Franken (D-Minn.) who was called on next to question Price had his own comment on the risk pool idea: “I’ll tell you how to get a really big risk pool — it’s called Medicare for everyone,” he said.

Price also discussed the Meaningful Use regulations for physicians’ use of electronic health records. “Electronic medical records and electronic health records (EHRs) are so important because … they allow the patient the opportunity to have their health history with them at all times, and allow the provider access to that,” he said. “We in the federal government have a role [in EHRs], but that role ought to be interoperability, to make certain that different systems can talk to each other so it inures to the benefit of the patient.”

But the Meaningful Use rules have really been burdensome for doctors, Price added. “I have had more than one physician tell me that the final regulations and rules related to Meaningful Use were the final straw for them … and they quit.”

“I think the thing that’s absolutely imperative, is to find out what things ought to be determined and checked … that the metrics used actually correlate with what’s being provided … so if we truly worked with those providing the care, saying, ‘What is it that we could ask you to measure that would really correlate with the outcome and quality of care provided,’ I suspect there’s some really specific things we could use.”

“Hope those watching are reassured by what they heard from you,” committee chairman Sen. Lamar Alexander (R-Tenn.) said as the hearing concluded. “While we intend to repair damage from Obamacare and that would mean repealing major parts of it, that won’t become effective until alternatives are in place … we don’t want to pull the rug out from everybody.”

Volunteers deliver petitions to the Senate HELP Committee with more than 510,000 signatures from people opposing the nomination of Rep. Tom Price, MD, as Health and Human Services secretary. (Photo by Shannon Firth)

Voices Opposed

Just before the hearing began Wednesday morning, representatives of Planned Parenthood, the National Physicians Alliance, Physicians for a National Health Program, and Public Citizen, hand-delivered stacks of boxes containing various anti-Price petitions that they report include 500,000 signatures.

“As a physician, it just doesn’t look like he puts the interests of patients first,” said Susan Molchan, MD, a psychiatrist, nuclear medicine physician, and member of the board of directors for the National Physicians Alliance, told MedPage Today.

Molchan cited his stock buys in tobacco companies as evidence that Price has put corporate interests ahead of patients. Price opposed regulating nicotine as a drug, but Molchan said “nicotine has clearly been accepted as a drug, a very addictive drug for years.”

Price’s support for privatizing Medicare, by transitioning to a voucher-like program for future beneficiaries, also worried Molchan.

“To throw Medicare, which has much lower overhead than private insurance … into the grinder of private health would be terrible.” While she acknowledged that Medicare has its flaws, “it works better than the private health industry, which is out for big corporate entities,” she said.

If his nomination is confirmed, Price’s leadership, “will further erode standards for the approval of medical devices and the approval of drugs,” said Sammy Almashat, MD, MPH a research associate for Public Citizen’s Health Research Group based here.

“We’re very concerned that his presence [at HHS] will send a message to the FDA that the standards should be lowered even further than they already have been.”

His support for repealing the Affordable Care makes him “very dangerous” particularly for Americans with life-threatening diseases such as cancer and HIV and other chronic diseases, he said.

“[G]utting the minimal safety nets that still exist in the form of Medicare, in the form of the Affordable Care Act, would be disastrous for those patients. As a physician, I don’t see how another physician could support such policies.”